Interstitial cystitis (IC) is a chronic inflammatory condition of unknown etiology which affects the mucosa and the muscularis of the bladder. IC is estimated to affect 450,000 people, 90% being women.
IC has a number of consistent symptoms, including hyperactive voiding and severe, debilitating pain. Current methods of treating IC or its symptoms have been largely unsuccessful. Common treatments include intravesicular instillations of medications such as heparin, dimethyl sulfoxide (for inflammation), sodium oxychlorosene (detergent), silver nitrate, and chromolymn sodium. While not offering significant improvements, these treatments themselves inflict further pain. More extreme intervention includes a cystectomy (removal of the bladder). Unfortunately, even after removal of the bladder, patients may continue to experience a level of pain consistent with that experienced prior to the procedure.
IC pain is largely visceral in nature. Visceral pain is produced in response to inflammation, distention, or increased pressure and is not necessarily due to visceral injury. Visceral pain is not well localized. IC pain may also include a neuropathic component. Consistent with some of the believed physiological understanding of IC, neuropathic pain is usually related to a nerve disruption. The pain associated with IC, being in some instances more severe than advanced cancer pain, may be intermittent or continuous.
Because of the lack of understanding of the disorder, pain management for IC is difficult. Common pain management practices currently include administering analgesic medications. For mild to moderate pain, acetaminophen, aspirin, or other nonsteroidal, antiinflammatory agents are utilized. For more severe pain, opioid medications (for example, morphine, hydromorphone, levorphanol, methadone, fentanyl, oxycodone, and hydrocodone) may be used. Of course, while opioids may provide some temporary relief, physicians must be concerned about potential side effects and the development of patient addictions.
While alternatives to opioid-only treatments exist, the success (or believed success) of the alternatives to effectively reduce that pain experienced over an extended period of time is not appreciably greater, if even greater, than that achievable through the opioid-only treatments. Alternatives to opioid use, or combinations which lessen the dependence on opioids, include: tricyclic antidepressants (offers moderate pain relief but can induce convulsions and hepatotoxicity as side effects as well as other, less severe side effects), anticonvulsants and antiarrhythmics (helpful in treating the neuropathic pain component of IC pain), and banzodiazepines. As another alternative, local anesthetics (for example, small, systemically inactive doses of opiate medications) could be applied to the bladder or pain transmitting nerves of associated with the bladder. Further alternatives may include: injection of local anaesthetics, opiates, or neurolytic agents into certain nerves using a superior hypogastric nerve block, intraspinal injection of opioids (with or without local anesthetics), intrathecal infusions of opioids (without or without local anesthetics), application of electrical stimulation external to the body (i.e., TENS stimulation), physically interrupting pain-transmitting nerves, and psychological treatments.
In addition to IC, a variety of disorders can induce chronic, severe pelvic pain of which there is no readily available treatment or answer for the symptomatic chronic severe pain. For reference, some of these conditions include, but are not limited to, lumbosacral radiculitis, lumbosacral radiculopathy, lumbosacral plexitis, lumbosacral plexopathy, vulvadynia, coccygodynia, peripheral neuritis, and peripheral neuropathy.
Accordingly, a need exists for at least a method of treating the pain produced from IC as well as other disorders which afflict the pelvic region. It is desired that the method should consciously avoid the perils of relying upon conventional drug treatments as well as avoid extreme irreversible intervention.